Cannabis Use and Sleep Quality in Daily Life: a Daily Diary Study of Adults Starting Cannabis for Health Concerns

Background: Legalization of cannabis for medical uses has proceeded without well-controlled study of its efficacy and safety for most indications. Real world patterns of medical cannabis use are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with web-based and smartphone assessment methods, designed to understand ecologically valid patterns of medical cannabis use and health symptoms, can help clarify the risks and benefits of cannabis use for medical indications. Methods: As part of a larger, randomized trial (NCT03224468), adults (N=181) seeking medical cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or to a waitlist control (WLC) and subsequently completed 12-weeks of daily web-based surveys on cannabis use and three health outcomes: sleep, pain, and depressive symptoms. Results: Completion rates of daily surveys in this long-term, web-based survey design were moderate to high across participants (median number of daily assessments completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Within the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increased cannabis frequency rather than a sustained effect of any single cannabis use. Daily associations between cannabis use and self-reported pain or depressive symptoms were small and not significant. Conclusion: Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Long-term, daily web-based assessments of cannabis appear valid and feasible in medical cannabis users, providing a robust method for future real-world effectiveness studies with expanded and objective measures. .